Yoshida Naoya, Horinouchi Tomo, Eto Kojiro, Harada Kazuto, Sawayama Hiroshi, Imamura Yu, Iwatsuki Masaaki, Ishimoto Takatsugu, Baba Yoshifumi, Miyamoto Yuji, Watanabe Masayuki, Baba Hideo
From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Division of Translational Research and Advanced Treatment against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan.
Ann Surg Open. 2022 Mar 28;3(2):e153. doi: 10.1097/AS9.0000000000000153. eCollection 2022 Jun.
This comprehensive analysis aimed to elucidate the mechanism underlying how high pretreatment red blood cell distribution width (RDW) reflects poor prognosis after esophagectomy for esophageal cancer.
Several cohort studies have reported that preoperative RDW might be a predictive marker for poor prognosis after esophagectomy; however, the underlying mechanism of this relationship has not been elucidated.
This study included 626 patients with esophageal cancer who underwent esophagectomy between April 2005 and November 2020. A retrospective investigation of the association between pretreatment RDW and clinicopathological features, blood data, short-term outcomes, and prognosis was conducted using a prospectively entered institutional clinical database and the latest follow-up data.
Of 626 patients, 87 (13.9%) had a high pretreatment RDW. High RDW was significantly associated with several disadvantageous characteristics regarding performance status, the American Society of Anesthesiologists physical status, respiratory comorbidity, and nutritional status. Similarly, high RDW correlated with frequent postoperative morbidities (respiratory morbidity and reoperation; = 0.022 and 0.034, respectively), decreased opportunities for adjuvant chemotherapy ( = 0.0062), and increased death from causes other than esophageal cancer ( = 0.046). Finally, RDW could be an independent predictor of survival after esophagectomy (hazard ratio, 1.47; 95% confidence interval, 1.009-2.148; = 0.045).
High pretreatment RDW reflected various adverse backgrounds and it could be a surrogate marker of poor prognosis in patients who have undergone esophagectomy for esophageal cancer.
本综合分析旨在阐明术前红细胞分布宽度（RDW）升高反映食管癌切除术后预后不良的潜在机制。
多项队列研究报告称，术前RDW可能是食管癌切除术后预后不良的预测指标；然而，这种关系的潜在机制尚未阐明。
本研究纳入了2005年4月至2020年11月期间接受食管癌切除术的626例患者。利用前瞻性录入的机构临床数据库和最新随访数据，对术前RDW与临床病理特征、血液数据、短期结局和预后之间的关联进行回顾性调查。
在626例患者中，87例（13.9%）术前RDW升高。RDW升高与身体状况、美国麻醉医师协会身体状况、呼吸合并症和营养状况等几个不利特征显著相关。同样，RDW升高与术后并发症频繁发生（呼吸并发症和再次手术；分别为P = 0.022和0.034）、辅助化疗机会减少（P = 0.0062）以及食管癌以外原因导致的死亡增加（P = 0.046）相关。最后，RDW可能是食管癌切除术后生存的独立预测指标（风险比，1.47；95%置信区间，1.009 - 2.148；P = 0.045）。
术前RDW升高反映了各种不良背景，它可能是接受食管癌切除术患者预后不良的替代指标。
